Bilateral angle-closure attack in a COVID-19-positive patient

Ophthalmic examination of a patient with active COVID-19 infection can be challenging. We describe a woman with active COVID-19 infection who was misdiagnosed initially as having conjunctivitis and later presented with acute angle-closure attack in both eyes. Intraocular pressure (IOP) on presentation was about 40 mmHg in both eyes. She was on multiple medications for her COVID-19 infection. A nonpupillary block mechanism of secondary angle closure was suspected and laser iridotomy was avoided. Her IOP was well controlled with medications. Due to significant cataract, phacoemulsification with IOL was performed using femto-assisted rhexis in lieu of the postdilatation IOP spike. There was good IOP control and 6/6 vision postoperatively. Bilateral angle closure of probable multifactorial cause can occur in COVID-19-positive patients.